Isoflurane Induces Endothelial Apoptosis of the Post-Hypoxic Blood-Brain Barrier in a Transdifferentiated Human Umbilical Vein Edothelial Cell Model

Isoflurane is a popular volatile anesthetic agent used in humans as well as in experimental animal research. In previous animal studies of the blood-brain barrier (BBB), observations towards an increased permeability after exposure to isoflurane are reported. In this study we investigated the effect of a 2-hour isoflurane exposure on apoptosis of the cerebral endothelium following 24 hours of hypoxia in an in vitro BBB model using astrocyte-conditioned human umbilical vein endothelial cells (AC-HUVECs). Apoptosis of AC-HUVECs was investigated using light microscopy of the native culture for morphological changes, Western blot (WB) analysis of Bax and Bcl-2, and a TUNEL assay. Treatment of AC-HUVECs with isoflurane resulted in severe cellular morphological changes and a significant dose-dependent increase in DNA fragmentation, which was observed during the TUNEL assay analysis. WB analysis confirmed increases in pro-apoptotic Bax levels at 4 hours and 24 hours and decreases in anti-apoptotic Bcl-2 in a dose-dependent manner compared with the control group. These negative effects of isoflurane on the BBB after a hypoxic challenge need to be taken into account not only in experimental stroke research, but possibly also in clinical practice

Können wir unseren Fachbüchern vertrauen? - Leitlinienkonformität deutscher Lehrbücher bei der präklinischen Behandlung des Schlaganfalls

HINTERGRUND: Bei der Therapie des Schlaganfalls spielt die präklinische Versorgung eine wichtige Rolle. Ziel unseres Projekts war es, die Vollständigkeit und Zuverlässigkeit von medizinischen Lehrbüchern mit Therapieanleitungen zur präklinischen Schlaganfallversorgung zu untersuchen. Lehrbücher sind für Ärzte wie Studenten nach wie vor, trotz der aufkommenden Alternativen in Form digitaler Medien, sehr wichtige Informationsquellen für Examina und medizinische Entscheidungen. METHODEN: Wir führten eine systematische Lehrbuch-Literatursuche gemäß den PRISMA-Kriterien durch. Die Inhalte zur präklinischen Therapie des Schlaganfalls wurden durch zwei unabhängige Untersucher evaluiert. Qualitätsstandard der Evaluation waren die aktuellen Schlaganfall-Leitlinien. Die endgültige Bewertung erfolgte in einem Konsensus Prozess. ERGEBNISSE: Von 68 Lehrbüchern zur Notfallmedizin zwischen 2011 und 2014 konnten 16 mit Inhalten zur präklinischen Therapie des Schlaganfalls bewertet werden. Die meisten untersuchten Lehrbücher zeigten gravierende Auslassungen und Abweichungen im Vergleich zu den Handlungsempfehlungen anerkannter aktueller Leitlinien. In fast allen Büchern fehlten die Quellennachweise. ZUSAMMENFASSUNG: Die meisten Notfallmedizinlehrbücher zur präklinischen Therapie des Schlaganfalls vermitteln momentan nicht die notwendigen Inhalte für eine erfolgreiche Therapie. Wegen fehlender Quellenangaben fehlt den Lesern auch die Möglichkeit Wissensinhalte nachzuvollziehen und zu vertiefen. Es ist dringend notwendig Lehrbuchinhalte auf einen Qualitätsstandard zu bringen, wie er von der evidenz-basierten Medizin gefordert wird

Hyperperfusion Syndrome After MCA Embolectomy - a rare complication?

Patient: Female, 78 Final Diagnosis: Cerebral hyperperfusion syndrome Symptoms: — Medication: — Clinical Procedure: Endovascular embolectomy Specialty: Neurology Objective: Unknown ethiology Background: Cerebral hyperperfusion syndrome (cHS) is a well known but rare complication after carotid endarterectomy, carotid angioplasty with stenting, and stenting of intracranial arterial stenosis. The clinical presentation may vary from acute onset of focal oedema (stroke-like presentation) and intracerbral hemorrhage to delayed (>24h hours after the procedure) presentation with seizures, focal motor weakness, or late intracerebral hemorrhage. The incidence of cHS after carotid endarterectomy ranges from 0–3% and defined as an increase of the ipsilateral cerebral blood flow up to 40% over baseline in ultrasound. Case Report: We present a case of a 78-year-old woman with an acute ischemic stroke due to left side middle cerebral artery territory with right sided hemiparesis and aphasia (NIHSS 16). After systemic thrombolysis embolectomy using a retractable stent (Solitaire® device) was performed and resulted in complete and successful recanalization of MCA including its branches about 210 minutes after symptom onset but, partial dislocation of thrombotic material into the anterior cerebral artery (ACA). Conclusions: Cerebral hyperperfusion syndrome should be considered in patients with clinical deterioration after successful recanalisation and the early diagnosis and treatment may be important for neurological outcome after endovascular embolectomy Keywords: embolectomy, hyperperfusion syndrome, ischemic stroke, middle cerebral artery occlusio

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Émile Gaboriau'nun Tercüman-ı Hakikat'te yayımlanan Cani Vahşi adlı romanının ilk ve son tefrikalar

Case report: A complicated course of Collet-Sicard syndrome after internal carotid artery dissection and lenticulo-striatal artery infarction

A 40-year-old Caucasian man presented with sudden onset of left-sided hemiparesis associated with dysphonia, dysphagia, and right-sided weakness on shoulder elevation and head rotation. The clinical examination revealed deviation of the tongue to the right, absence of right-sided gag reflex, right-sided palatal and vocal cord paresis, and weakness of the right trapezius and sternocleidomastoid muscles; all were in addition to left-sided brachiocephalic-accentuated hemiparesis. The diagnostic examination revealed dissection of the right carotid artery with occlusion of the middle cerebral artery and infarction in the lenticular-striatal artery territory. Mechanical thrombectomy with stent angioplasty of the right internal carotid artery was performed. The paresis of the left side of the body completely regressed within a week after symptom onset, but the dysphonia, weakness of the right trapezius and sternocleidomastoid muscles, and especially dysphagia persisted and regressed slowly but gradually. The patient required percutaneous gastric tube feeding for the next 12 weeks, possibly because of involvement of subcortical white matter tracts. The constellation of symptoms and clinical findings were consistent with Collet-Sicard syndrome, an extremely rare disorder caused by direct compression of the caudal cranial nerves at the base of the skull

Quality assessment of optic nerve sheath diameter ultrasonography: Scoping literature review and Delphi protocol.

BACKGROUND AND PURPOSE: The optic nerve is surrounded by the extension of meningeal coverings of the brain. When the pressure in the cerebrospinal fluid increases, it causes a distention of the optic nerve sheath diameter (ONSD), which allows the use of this measurement by ultrasonography (US) as a noninvasive surrogate of elevated intracranial pressure. However, ONSD measurements in the literature have exhibited significant heterogeneity, suggesting a need for consensus on ONSD image acquisition and measurement. We aim to establish a consensus for an ONSD US Quality Criteria Checklist (ONSD US QCC). METHODS: A scoping systematic review of published ultrasound ONSD imaging and measurement criteria was performed to guide the development of a preliminary ONSD US QCC that will undergo a modified Delphi study to reach expert consensus on ONSD quality criteria. The protocol of this modified Delphi study is presented in this manuscript. RESULTS: A total of 357 ultrasound studies were included in the review. Quality criteria were evaluated under five categories: probe selection, safety, positioning, image acquisition, and measurement. CONCLUSIONS: This review and Delphi protocol aim to establish ONSD US QCC. A broad consensus from this process may reduce the variability of ONSD measurements in future studies, which would ultimately translate into improved ONSD clinical applications. This protocol was reviewed and endorsed by the German Society of Ultrasound in Medicine